The proposed deals will redraw the lines around what defines healthcare companies by putting different business all under one roof. In turn, the deals give the consolidated healthcare companies more leverage when it comes to paying for prescriptions and medical care.

That puts pressure on the biotech and pharmaceutical companies that make the drugs, putting them in a position where they have less leverage when negotiating how the drug will get paid for. To counter that, biotech and pharma will have to do big deals of their own, Goldman Sachs analysts wrote in a note Friday.

"We think large transformative deals would create companies with therapeutic leadership, more negotiating leverage with payers, synergy potential, and portfolio reshaping," they said.

But, the analysts said, it will take a "detonator" to initiate that consolidation, borrowing a phrase Pfizer CEO Ian Read used in a January 2018 earnings call.

Goldman Sachs said the companies in the position to be that "detonator" — those with the "highest M&A firepower" are:

Roche

Johnson & Johnson

Gilead

Pfizer

Amgen

Merck

On the flipside, Goldman Sachs said there's only three companies — AstraZeneca, Bristol-Myers Squibb, and Eli Lilly — that would make for good acquisition candidates based on their drug pipelines and low operating margins.